Singaporeans’ affair with Western-style fast food: Unhealthy and possibly deadly

A diet heavy in Western-style fast food is known to make people fat and unhealthy, and a recent study quantifies its toll in an Eastern population, particularly Singaporeans: Frequent intake puts one at risk of developing type 2 diabetes (T2D) and dying from coronary heart disease (CHD).

Typically dense in calories and served in large portions, Western-style fast foods comprise of processed meat and highly refined carbohydrates, with excessive levels of sodium and cholesterol and a poor dietary fatty acid profile. This aligns with historical evidence linking fast food diet with epidemic cardiovascular disease and T2D. [Lancet 2005;365:36-42; N Engl J Med 2006;354:1650-1652; J Am Diet Assoc 2008;108:287-331; Metab Syndr Relat Disord 2010;8:471-476]

In the current study involving Chinese Singaporeans, eating Western-style fast food products at least two times per week increased the risk of incident T2D by 27 percent (hazard ratio [HR], 1.27, 95 percent confidence interval [CI], 1.03–1.54) and CHD mortality by 56 percent (HR, 1.56, 95 percent CI, 1.18–2.06) when compared with little to no reported intake. [Circulation 2012;126:182-188]

The observed associations were not substantially altered by adjustments for overall dietary pattern, energy intake, and body mass index.

“We wanted to examine the association of Western-style fast food with cardiometabolic risk in a Chinese population in Southeast Asia that has become a hotbed for diabetes and heart disease,” said lead investigator Dr Andrew Odegaard, a postdoctoral researcher from University of Minnesota in Minneapolis, Minnesota, US.

“What we found was a dramatic public health impact by fast food, a product that is primarily a Western import into a completely new market,” Odegaard added.

Odegaard and colleagues used data from the Singapore Chinese Health Study from 1993 to 1998, which involved Chinese men and women aged 45–74 years of age. The analysis for CHD mortality included 52,584 participants and 1,397 deaths, while that for T2D included 43,176 participants and 2,252 cases.

The baseline characteristics for those in the T2D analysis mirrored those in the CHD analysis across all factors. Of note, participants reporting more frequent intake of Western-style fast food were younger, less likely to be hypertensive, more educated, more likely to be physically active, and smoked less.

With more frequent intake of Western-style fast food, consumption of vegetables (excluding white potatoes), dairy products, rice, and overall carbohydrate and dietary fibre decreased. On the contrary, a higher consumption of noodles, Eastern snacks and dim sum, and sugar-sweetened beverages were accompanied by a greater intake of protein, saturated and polyunsaturated fatty acids, dietary cholesterol, sodium, and total energy.

“What's interesting about the results is that study participants who reported eating fast food most frequently [had a] profile [that] is normally associated with lower cardiometabolic risk,” Odegaard noted.

Odegaard and colleagues believe that their findings may provide context for populations that have recently undergone or are undergoing nutrition transitions and are experiencing the parallel changes in health. [Am J Clin Nutr 2006;84:289-298]

“Current and preceding generations in the US have been widely exposed to Western-style fast foods throughout their lifetimes. However, Western-style fast food intake in East and Southeast Asia started becoming somewhat prominent in the late 1980s and early 1990s, providing a chance to participate in American culture, which is very different from the historical dietary culture of these populations,” they pointed out.

The study’s senior investigator Dr Mark Pereira of the University of Minnesota’s School of Public Health's Division of Epidemiology and Community Health pointed out that the fast-food aspect of globalization and exportation of US and Western culture might not be the best thing to spread to cultures around the world.

“Global public health efforts should focus on maintaining the positive aspects of traditional cultures, while preventing the spread of outside influences thought to be harmful based on the scientific evidence,” Pereira added.